B-More Dog's Minor Waiver

Please complete all fields below if your child is under 18 years of age and will be volunteering with B-More Dog. Thank you.

I hereby certify that I am the adult parent or guardian of the minor child ("Child") named below, who is under the age of eighteen years. I hereby acknowledge that I have voluntarily requested for my minor child to participate in providing volunteer service to B-More Dog. As lawful consideration for my minor child being permitted by B-More Dog to participate in providing volunteer service, I hereby fully and forever release, discharge, acquit and exonerate B-More Dog, its affiliates, and their employees, officers, directors, volunteers, interns, and all others acting on their behalf from any and all actions, causes of action, claims, or liabilities that I have or my minor child has or may have in the future, whether known or unknown, arising out of or related in any way to the volunteer duties of my minor child.

I understand there are certain risks and dangers associated with working with wild, feral and domesticated animals, including but not limited to, bites, scratches, zoonotic diseases (diseases transmitted from animals to humans) including, for example, but without limitation, rabies, and allergic reactions. I know there may also be risks involved with exposure to certain chemical cleaning products while my minor child performs volunteer duties. I fully understand these risks and dangers. I assume all risks in connection with my child providing volunteer service to B-More Dog and I expressly waive any claims for injury or loss arising from my child providing volunteer service to B-More Dog. I understand that B-More Dog shall have no responsibility to pay for medical treatment and related costs if my minor child is injured. I am voluntarily allowing my child to participate with the knowledge of the danger involved and hereby agree to accept any and all risks of injury to my minor child.

I fully assume all the risks involved, acknowledge that they are acceptable to me, and recognize my responsibility to ensure that my minor child participates only in those activities for which he/she has the required skills, qualifications, training and physical conditioning, and agree that my minor child has the capacity to follow the rules and safety instructions as given by B-More Dog directors and volunteers authorized to act in a supervisory capacity. I waive, and release B-More Dog, its affiliates, and their employees, officers, directors, volunteers, interns, and all others acting on their behalf from, any claim for personal injury, property damage, or death however caused or for which my minor child may be liable to any other person, resulting from any cause whatsoever, and regardless of fault, as a result of my minor child engaging in volunteer services for B-More Dog.

I HAVE CAREFULLY READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND ITS CONTENTS. As parent or legal guardian of the minor child, I have completely reviewed this Waiver and Release, understand and consent to its terms, and authorizes my minor child’s participation. I also acknowledge that there are no warranties implied concerning the facilities or the activities engaged in by my minor child during volunteer services for B-More Dog. I also acknowledge that I am signing this contract of my own free will. I am aware that this is a RELEASE OF LIABILITY and a contract between me and B-More Dog, its affiliates, and their employees, officers, directors, volunteers, interns, and all others acting on their behalf, and I accept it of my own free will. I understand and agree that no oral or written representations can or will alter the contents of this document.

By signing below, I acknowledge that the information provided is correct to the best of my knowledge. If at any time the information I have provided changes, I will provide the updated information to B-More Dog.

Electronic Signature *

Type your first and last name in the box below to indicate your acceptance of these terms. This will act as your signature and indicates your agreement to be bound by these terms.

Child's Name *

Child's Name

First Name

Last Name

Child's Date of Birth *

Parent or Guardian's Name *

Parent or Guardian's Name

First Name

Last Name

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone *

Home Phone

(###)

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Cell Phone *

Cell Phone

(###)

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Name of Emergency Contact #1 *

Name of Emergency Contact #1

First Name

Last Name

Phone Number of Emergency Contact #1 *

Phone Number of Emergency Contact #1

(###)

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Name of Emergency Contact #2 *

Name of Emergency Contact #2

First Name

Last Name

Phone of Emergency Contact #2 *

Phone of Emergency Contact #2

(###)

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Name and Contact Phone Number for Child's Physician *

Name of Medical Insurance Carrier for Child's Policy *

CONSENT TO MEDICAL TREATMENT AND MEDICAL RELEASE FOR MINOR *

If emergency care is required for the above-named Child, and permission is not available from a parent or legal guardian in a timely manner, then I, the undersigned, authorize appropriate emergency medical care as deemed necessary by emergency medical personnel, a physician or the medical facility providing treatment for the purpose of attempting to treat or relieve any injuries received by said minor while s/he was a participant or observer at the event hosted by B-More Dog. I authorize any licensed physician to perform any procedure which s/he deems advisable in attempting to treat or relieve any injuries or any related unhealthy condition of said minor that s/he may encounter during any necessary operation. I consent to the administration of anesthesia as deemed advisable by any licensed physician. I realize and appreciate that there is a possibility of complications and unforeseen circumstances in any medical treatment and I assume any such risk on the behalf of myself and said minor I acknowledge that no warranty is being made as to the results of any treatment. I have read this entire release and agree to it.
Type your first and last name in the box below to indicate your acceptance of these terms. This will act as your signature and indicates your agreement to be bound by these terms.